February 16, 2003
Insulin Pumps
Question from Lancaster,California, USA:
My daughter’s blood sugars started spiking all the time, and I feel she isn’t in control. She will be fine for a few days, then she will be in the 200-400s mg/dl [11.1-22.2 mmol/L]. She is on a very strict diet, and today did five shots. She is starting into puberty, and I realize this can play a big part.
I have recently met with my daughters’ pediatrician, we inquired about the insulin pump, and she said because my daughter isn’t in control that she wouldn’t even consider her for it. When I requested that she see an endocrinologist, the doctor said we still needed to get her in better control first. Wouldn’t the specialist be more up to date and helpful? Wouldn’t the insulin pump help maintain better “tighter” control? In our area, there is only two endocrinologists, only one is in my insurance plan, I have to have a referral, and the pediatrician won’t give me a referral.
Answer:
It sounds like you should have a consultation with a pediatric diabetologist before doing anything else. Whether or not an insulin pump would be wise is only a decision that can be made working together with an experienced diabetes team and your family. If your pediatrician refuses to authorize a referral to specialist, then change pediatricians.
There are now several research studies documenting that specialty care in diabetes is superior to generalist care. Our own team just wrote a review article about multidisciplinary diabetes care for children and adolescents that reviews these concepts and was published in Journal of Pediatric Endocrinology and Metabolism, October 2002 issue (Brink, Moltz and Miller are the authors). You can use this article and many others like it to justify referrals with your pediatrician and insurance carrier.
SB
